Chopped Liver It Ain’t!

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Jimmy Durante is reported to have been the first person to use the phrase “What Am I – Chopped Liver?” in a 1954 movie.  Chopped liver is generally not served as a main dish, so it became a term referring to something not well-regarded or important.  Well, when talking about the human liver, it is just the opposite!  The liver is so important because it does about 500 different jobs.  It does everything from purifying blood to clotting it, from storing excess blood sugar to making it available again when we need it, from removing bacteria in the blood to breaking down fats in our food so they can easily be digested, and so much more.

According to the Cleveland Clinic, you have a greater chance of developing fatty liver disease if you are Hispanic or Asian, if you are a post-menopausal woman, if you have obesity with a high level of belly fat, if you have high blood pressure, diabetes, or high cholesterol, or if you have sleep apnea – a blocked airway that causes breathing to stop and start during sleep.  What’s interesting about this list is that it doesn’t mention alcohol.  While alcohol can do enormous damage to a liver, so can excess stored fat without any alcohol intake.  You don’t have to drink a drop of alcohol and you can still get liver disease.

The liver must be treated well to keep up the good job it normally does.  If it isn’t, it can accumulate excess fat, causing a condition called Non-Alcoholic Fatty Liver Disease or NAFLD.  The fat increases in the liver by eating too many empty calories from processed foods and sugar.  Eating an unhealthy diet can also contribute to diabetes and to obesity.  The excess fat causes inflammation of the liver.  As this persists and worsens, the liver can become scarred, and a person can develop Non-Alcoholic Steatohepatitis (NASH).  If this trend is not interrupted by preventive measures, a person may develop cirrhosis (severe scarring) of the liver and even hepatic cancer.  Sounds awful, right?  It is if it isn’t taken care of early on, but it can be prevented and, in some cases, even partially reversed.

The liver is a hardy organ, for sure, but unfortunately it is not always obvious when it is falling down on the job.  How would you know if you had NAFLD?  It’s very likely you wouldn’t be suspicious that something is wrong until it becomes more advanced.  Some people will notice that they feel fatigued or have some pain in the upper right side of the abdomen – your liver is there under the rib cage.  If you have a more advanced issue like NASH, you might notice your belly is getting swollen or you see veins right under the surface of your skin near the liver.  The palms of your hands can turn red, and your skin and eyes are a clue, too, as they can begin to turn yellow.

If your liver is severely damaged from cirrhosis, there is no way for the cells to function properly or the blood supply to go where it’s supposed to.  There are no specific medicines to treat NASH, and the only option is to have a liver transplant when it gets severe.  Those are not easy to come by as there are between 13,000 and 15,000 people waiting for liver transplants at any given time in the United States.  Life after transplant is still a great challenge, as well.

Initially, a blood test looking at different enzymes in the liver to see if their levels are within the normal range, is usually done as part of an annual physical.  If abnormal, a biopsy (taking a little piece of liver tissue) may be done to see if any significant damage or scarring has occurred.  And those preventive measures I mentioned earlier… it all goes back to diet and exercise.  I know, they may be your two least favorite words in the language.  They certainly were mine for much of my life.

For many years, I had wacky liver test results because of my diet and weight.  Big bellies, high blood pressure, sleep apnea, and diabetes are greater health problems with truckers than in the general population, and much of it is due to lack of exercise and fast-food options that are, well… fast – but that’s about it.  These types of meals are not very nutritious and certainly contribute to weight gain and excess fat building up in the liver.

So, what’s a trucker to do?  Well, for starters, think about one or two minor changes you could make in your diet that wouldn’t ruin your day.  For example, if you usually drink five sugary sodas a day, drink three instead.  That’s progress!  Is the biggest burger you can possibly buy usually on your menu when you stop to eat?  Maybe buy a smaller version or eat only half the french fries that come with it.  That’s progress!  Salad vs. onion rings?  Go for the salad from time to time.  The alternative is to choose vegetables, fruits, whole grains, and lean meats and fish.

Changing your eating is one of the most difficult things a person can do.  It is, however, one of the most rewarding things because you will undoubtedly feel better as you eat better.  The best chance for success usually comes with joining some sort of a program – think My Fitness Pal (free) or Noom (not free but there are some studies that show if you pay for a program, you are likely to get more out of it).  They both have apps for your smart phone, or you can use a computer to track your food and progress.  In a million years I would never have imagined myself logging food and exercise, but I do it now, and my liver is back to normal.

So, the decision is yours – do what you can today to start decreasing your risk of fat build-up in your liver or pick out the hospital where you want to have your liver transplant.  There.  I said it.  Now, doesn’t that make the decision a little easier?  Your future is in your hands, and it ain’t chopped liver!

~ Norma Stephens Hannigan is a Doctor of Nursing Practice who recently retired after a 43-year career providing direct care and teaching future nurses and nurse practitioners.  Dr. Norma has treated many truck drivers at the various clinics she has worked.  She currently writes for 10-4 from her home in New York.

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